Das Cloud analyses the answers to the question “What do Google searches of the past three years reveal about the Romanian web surfer’s health?”, and brings you a premiere diagnosis in Romania’s data journalism.
INTRODUCTION AND METHODOLOGY
These are the facts known before the question: four out of five web surfers in Europe, China, Russia and the USA use search engines to research potential ailments, with half of these doing it for self-diagnosis – as revealed by a Pew Research Center study. In fact, when compiling internet information for self-diagnosis, over 95% of patients use a search engine, as shown in this report by the WHO (World Health Organizațion.
In the .ro, sfatulmedicului.ro registered 2.6 million unique visitors last month – a remarkable feat, considering that, according to Eurostat numbers, Romania has no more than 10 million Internet users (54% of households had Internet access in 2012, up from 38% in 2009 and 16% in 2006.
In 2012’s Zeitgeist, two of the top ten “what is…” questions on google.ro were about gout and rubella.
After going through dozens of search words, we picked 14 high volume searched terms constantly appearing along 3 years
For three months we condensed public information from Google Trends, structured and adapted it to formats that would allow us to better see beyond the numbers, and had Google’s help in selecting the most relevant medical searches made by Romanians in the past three years.
After going through dozens of search words, we picked 14 of the top searched terms every month, over a long period of time. We then used Media IQ – a press monitoring service built by two mathematicians and a programmer – to determine if and when Google search increases have been stimulated by press articles, and just how much influence online press actually has. Its effects are discussed at greater length in the INTERMEDIARY DIAGNOSIS sub-chapter.
If Google searches the whole internet, Media IQ only searches press websites, and can be viewed as a specialized search engine. “It’s the same difference as between an absolute and a specialized predator. They are the monster that kills and devours anything. We are niche predators”, as Media IQ’s Cătălin Cucu-Dumitrescu descriptively puts it.
Once the data sets were consolidated, Timișoara’s graphic and interactive design studio X3 designed an interactive graph to view them dynamically. These were, essentially, the steps of Romania’s first data-journalism project – a new field worldwide, which uses the huge amount of data we generate with every digital gesture (Big Data), and which entails a close collaboration between journalists, designers and programmers.
Click here to open the interactive graph (requires Flash).
What does the .ro-manian patient’s chart look like for the three years we examined? In January 2010 he was suspected of “swine flu”, and in June 2010 exhibited symptoms of “hepatitis C”; he was permanently, with no significant variation, presumed to have “shingles”; in January 2011 was plagued by “pancreatitis”, and March and April 2011 brought the “mite bite” scare (or the tick scare). The summer of 2011 brought the new worry of “lupus”, during a time when the Romanian press wrote that Andreea Marin may be suffering from the autoimmune disease; and the end of the year registered a mass search for “helicobacter pylori”.
The cold season brings an interest in “medical tests”, especially considering the new symptoms of “rubeola” and “measles” in the winter of 2011-2012, which turned into “meningitis” in June 2012. In fact, 2012 was the year when the 14 medical terms analyzed by Das Cloud registered their collective search peak. However, we must take into account the possibility that this is also a side effect of the increase in number of Romanian internet users.
“Interpretation may be subjective; one can become a hypochondriac who believes he has all the diseases” – physician Anca Marinescu
On the other hand, the Romanian patient doesn’t believe in traditional medicine and prefers nutritive supplements, swallowing up vast amounts of information about Colon Help, with a peak in March 2011. A look at the numbers registered by Zenyth Pharmaceuticals on the Ministry of Finances’ website – a business worth 24 million lei, with over 12.5 million lei in profit in 2011 – confirms the real purchases, besides the virtual interest in the topic.
In order to better understand why these spikes occur in the Romanian’s Google searches, we compared Google’s info with the media loudspeaker. With the help of Media IQ’s mathematicians, we monitored online news, accessing content by Romanian journalists. We noted the monthly number of occurrences, as well as examples of press articles that reflect Google trends.
As a general rule, Google searches go hand in hand with the press. Specifically, when the media covers a certain illness, the volume of adjacent searches grows exponentially, sometimes with a certain delay, as shown by Google statistics.
Generally, we could classify Romanian Google-ailments into three categories: seasonal, media-generated, and collateral to symptoms exhibited by a public figure. Let’s examine them:
1. Virals. They are mostly seasonal afflictions, which we could medically place in the category of acute diseases. Here we included chicken pox, scarlet fever, rubella, swine flu, measles and rubeola. Swine flu had the highest search spike in this category (368.48% in January 2011).
2. Media buzz. Here we included all the media-fueled outbreaks, even though the actual number of new cases on a national scale has not necessarily increased spectacularly. An example of a Google pandemic is hepatitis C, arising in the wake of the public testing campaign of May 2010. Lyme’s disease, caused by the bite of the infamous tick, was a search trending topic, with traditional media spreading the usual panic and doomsday scenarios. The April 2012 tick bites generated a 500% increase in searches from the previous month. Add the usual suspect, like actor Șerban Ionescu, and you have a complete recipe for a search pandemic.
3. VIP. Some of the ailments we analyzed crowded the search bar after being associated with Romanian public figures. Șerban Ionescu was the forerunner for “tick”, and Teo Trandafir for “pancreatitis”. In July 2011, the tabloid-supposed lupus of Andreea Marin triggered a 158.82% increase in Google searches, compared to the preceding month. However, we can’t completely rule out Doctor House’s contribution, and according to the master of differential diagnosis, “It’s never Lupus!” Andreea Marin also donated blood to a leukemia patient, and searches for the illness grew noticeably in October 2010.
But the absolute star of this category seems to be the shingles, with an April 2010 explosive growth of 3,000% from the preceding month, after the news that Diana Dumitrescu had been diagnosed with the disease.
3,000% – the rate of growth for Romanian Google searches for “shingles” in April 2010
CO.roLARY 1 – Atypical Symptoms
There are a few medical terms that registered massive searches, even though they are not part of the three above-mentioned categories: “Colon Help”, “Helicobacter pylori” and “medical tests”. Let’s “administer” them in turn.
Colon Help. Launched in 2010, the supplement was intensely promoted, including on TV, as curing a large range of ailments. “They began promoting it everywhere, and promising that it cured a large spectrum of pathologies: constipation, weight loss, detoxification, liver protection, lowering cholesterol levels, «cleansing» the blood”, a pharmacist explains to Das Cloud.
Helicobacter Pylori. It’s the bacteria that causes infectious ulcer. “It has developed a resistance to antibiotics, requiring an association of up to four classes of drugs for efficient eradication. It’s transmitted gastro-orally to hospital-admitted patients who have undergone procedures using insufficiently sterilized instruments. We may be talking of drug therapy failure, as its resistance can render the first therapy scheme inefficient”, medical doctor Vladimir Dumitrașcu says.
Medical tests. Most users searching Google for a generic term like “medical tests” want to decode what doctors write on their prescriptions after an examination, explains general physician Anca Marinescu, of the Dorobanți Center for Diagnosis and Treatment.
Searches for terms such as monocytes, leucocytes, lymphocytes and trombocytes suggest that Romanians either do not receive enough answers during their medical visit, or they do not pay enough attention to everything diagnosis-related, and they need to enhance their information post factum, once in front of a computer.
When Google fails to provide the desired answers, Romanians call upon the voice of the community. Ciprian Miron, a representative of sfatulmedicului.ro – a website offering online-mediated, long-distance medical consultations – says that Romanians mostly seek out an online doctor for genital conditions.
Such intimate afflictions are also brought to the attention of doctors active on the TPU social network. For Das Cloud, Brigaela – M.D. and TPU expert – compiles a list of health complaints that today’s teenagers display in public, under pseudonym.
1. Questions about sexual activity, potency, sexually transmitted diseases, virginity and its loss, medical tests recommended when changing partners or after having unprotected sex with a stranger.
2. Questions about signs and symptoms of pregnancy, pregnancy tests, and unusual methods of terminating pregnancy.
3. Questions about adverse reactions to drug treatments, often self-administered.
4. Questions about therapeutic recommendations of their current physician, and about which they desire a second opinion.
5. Questions about weight loss or weight gain plans.
“The most unusual questions have been inquiries for special regimen prescription drugs (for psychoactive purposes), and an absolute gem of a question where a boy asked me about new and innovative methods of masturbation”, says Brigaela.
What truly ails Romanians using their Google search fields towards medical results cannot be fully comprised from the volume of searches offered by the American company’s Romanian franchise.
Das Cloud talked to a few local specialists, to learn about the collective mental levels on medicine, but also about the limits of browser-based self-diagnosis.
There are two kinds of internet medical searches, explains general physician Anca Marinescu, of the Dorobanți Center for Diagnosis and Treatment. “First of all, there’s curiosity. They search for pancreatitis not because they have it, but because they want to know what’s wrong with Teo Trandafir, what’s her health status, what this disease is all about. Then there is the search by an actual patient. This is certainly a good thing, as long as they take their internet-based info with a grain of salt.” Except there are cases when the patient questions the physician’s authority, which is dangerous, she adds. “When he comes in and starts to contradict you because of something he read online, you have a problem. Because these search results are not tailored to every patient. I have a few clients who tell me: «Yes, I know, I’ve read it on the internet».”
Viorel Alexandrescu, of the Cantacuzino Institute, also concludes that the average Romanian has gotten used to researching his health online. “Before they ever see a physician, they usually search it on the internet. But the symptoms they search for are not exclusive to their own actual health. These can appear at any time, from any source: people around, public figures, institutions, internet campaigns. The man reads it and thinks: «Is it possible that I also have this disease?»”
The trend of self-diagnosis grows with bandwidth, Anca Marinescu also confirms. “The patients are definitely better informed about their ailments than they were a few years ago, before they came in contact with the internet.” But she also points to the other side of the coin. “The Internet is usually a tool in the hands of a novice. Interpretation may be subjective; one can become a hypochondriac who believes he has all the diseases. But diagnosis is a highly complex process, which you learn from more than just the six years of medical study. There are a lot of human algorithms when establishing a diagnosis.”
CO.roLARY 2 – Case Study
One of the people who understood the potential of Big Data and internet researching of symptoms is Viorel Alexandrescu, medical doctor, head of the Romanian National Center for Flu Reference, and program manager for epidemics and pandemics within the Cantacuzino Institute. A title to match the role – preventing the spread of flu epidemics in Romania –, but also bearing a responsibility where reaction time is crucial. The first signs of a potential epidemic alert the system to stack up on flu vaccines. The faster the mechanism, the fewer the patients. And the Internet can spread faster than the flu.
At the end of last year, the Cantacuzino Institute and Google Romania signed a partnership to build an alert system. Namely, when certain key words, associated with flu symptoms, register search spikes on google.ro, the alarm is triggered.
“We made a selection of these Google search key words. There are about a dozen of them: flu, viral infection, cold, fever, cough, secretion cough, headache, thoracic pain, muscle pain and joint pain, runny nose, general ill-being. There are more of them, we had about 30-40 initially but chose the most frequent ones”, Viorel Alexandrescu explains for Das Cloud. The system has yet to be tested in real-life conditions, as there have been no epidemics in the months since its implementation. But if the alarm is triggered, the authorities begin stacking up on flu vaccines, the hospitals prepare for admissions, and information campaigns are carried out in schools.
“An educated patient is a better patient, and a better partner to the health care provider” – Chris Bailey, WHO
In terms of speed, the system can surpass the classical epidemic certification system by seven days.
PANACEA OR ADJUVANT?
This growing medical e-alphabetization is a worldwide phenomenon. This is confirmed by Chris Bailey, e-health specialist with the World Health Organization (WHO), who believes the internet has brought democracy to medical information worldwide. “From WHO programs such as HINARI, which offers access to the literature of medical science to institutions of poor countries, to the expanding use of computers and phones in the remotest regions of the planet, an increasingly larger segment of the world population can understand how to access and use medical information available on the web”, he explains in an interview for Das Cloud.
“An educated patient is a better patient, and a better partner to the health care provider. And in areas where the medical system is lacking, offering people access to information that raises awareness to their health status is a major factor in strengthening community health and limiting the spread of contagious diseases”, the WHO representative continues.
So ultimately, what is Doctor Google’s role in the complex equation of healing? Alexandrescu believes that, at the present time, Google searches “short-circuit” a patient’s road to their physician: “You don’t tell your neighbor what ails you anymore, you search it online and then you go straight to the doctor.”, said Viorel Alexandrescu.
But none of the specialists interviewed by Das Cloud speak boldly of the infallible social intelligence, available online, completely replacing the classic medical act right away. And, although cyberhondria is the “it” internet illness of the moment, Romanians don’t blindly trust the web’s intelligence either. At least according to last year’s Reader’s Digest study, stating that 62% of Romanians trust the internet, as opposed to 76% trusting their physician.
How many people trust machine doctors? The question is not yet part of a questionnaire, but medicine is certainly a field of technological innovation. Which is blooming.
An IT system beat a team of doctors to the correct diagnosis, shows a recent study by a team of researchers from Indiana University. The computer they developed was tasked with analyzing and predicting the medical evolution of 500 patients. After inputting the relevant data – mainly concerning clinical depression or chronic disease like hypertension and diabetes – researchers Kris Hauser and Casey Bennett confirmed that the IT system was 42% better than real-life doctors at diagnosing and prescribing medication.
Editor’s note: a big thank you goes to Crina Caliman, a Das Cloud reader who managed to translate our not quite easy to translate romanian article.